Is there a regional solution to vaccine inequity?

The COVID-19 pandemic and subsequent global rollout of vaccines revealed the good, the bad and the ugly of the global community’s ability to come together and respond. The good – the delivery of safe and effective vaccines in under a year, saving nearly 15 million lives. The bad – despite vaccine development, there have been 6.6 million confirmed deaths, as of December 2022, and an estimated $14—28 trillion of economic damage globally. The ugly – inequitable vaccine rollout as vaccine nationalism and export bans disproportionately impacted low-income countries, during the early days of the pandemic in particular. As of December 2021, almost a year after the first COVID-19 vaccine was approved for use, high-income countries had achieved a two-fold higher vaccination rate than middle-income countries and a 20-fold higher rate than lower-income countries.

A major driving factor of outcomes was access to local vaccine manufacturing capacity. Rates of vaccine administration are clearly correlated with regional access to vaccine development and production capacity. Africa, for example, which imports over 99% of its vaccines, was last in the queue to receive vaccines.

The lack of equitable access to vaccines during a global health crisis underscores the need for strategic autonomy and self-reliance anchored in regionally-based vaccine manufacturing ecosystems, as a complement to existing global systems. Countries need greater control over strategic decisions and to develop right-sized pandemic preparedness responses that leverage new vaccine technologies; including, but not limited to, mRNA. Apart from a few select countries (US, China, Indonesia and India) most countries, acting independently, lack the scale and production capacity to sustain manufacturing in non-pandemic times and effectively surge manufacturing during pandemics. Meanwhile, global systems lack the political leverage to make rapid decisions and the authority to allocate vaccines equitably. This was demonstrated by the degree to which national self-interest drove decision-making and undermined global solidarity during the COVID-19 response.

Regions or coalitions of countries, however, offer an attractive complement to the global system by creating scale unachievable by individual countries and enabling the response speed that global systems have sometimes lacked. At the operational level, regions enable focus and the ability to target specific vaccine technologies for diseases of interest to the region. At a strategic level, regions could contribute to equitable access for countries, as well as pandemic resilience within and beyond national borders by strengthening public health infrastructure and countermeasure production for other communicable diseases.

In fact, successfully functioning regions already exist. The European Union, as a coalition of countries with the ability to produce vaccines from start to finish and a joint regulatory body, was able to secure vaccine supply and effectively respond to COVID-19. Other efforts to establish and/or strengthen regions are underway, including the WHO mRNA Hub, PAHO and the Africa Union. The latter, for example, has put forth a comprehensive plan to increase the percentage of African-produced vaccines used in the region from <1% to 60% by 2040.

To identify common needs and leading practices that facilitate the establishment of regional manufacturing efforts, the World Economic Forum launched the Regionalised Vaccine Manufacturing Collaborative (RVMC) at its Annual Meeting in Davos in May 2022. The RVMC, with CEPI and the US National Academy of Medicine as co-chairs, has convened discussions that have included: Africa CDC; Aspen Pharmacare; AstraZeneca; Bill & Melinda Gates Foundation; Biological E.; Biovac; Citi; DCVMN; FioCruz; Gavi; IFPMA; International Finance Corporation; International Monetary Fund; International Vaccine Institute; MedAccess; Moderna; Partnership for African Vaccine Manufacturing; PATH; Pfizer; SK Biosciences; UNICEF; USAID; Wellcome Trust; World Health Organization; World Trade Organization; various governments; and many other NGOs and industry partners. These discussions have resulted in the development of a roadmap consisting of seven pillars that define guiding principles and identify key issues for regionalisation.

The RVMC Framework offers a flexible path forward for any region with the ambition to introduce new technologies or to expand existing technologies to sustainably grow vaccine production in routine and pandemic times. The RVMC Framework also offers significant opportunities for new coalitions to form and to expand public and private participation that leverage novel instruments and technologies that sustainably increase capacity and improve health equity.

The role and goals that each pillar can play to form and support regional vaccine manufacturing coalitions is presented below:

1. Business models of manufacturers that are sustainable in routine (interpandemic) and pandemic times.

2. Market shaping according to healthy market framework principles that support long-term viable pricing with predictable supply and demand.

3. Public/private financing to support sustainable capacity expansion, de-risk industry investments, market shaping, advance purchase agreements and triple (financial, social and environmental) bottom-line returns

4. Manufacturing innovation to advance a region’s R&D and manufacturing technology capabilities to address future pandemics.

5. Technology transfer and workforce development that efficiently, effectively and repeatably enables regions to right-size manufacturing capacity at scale.

6. Supply chain ecosystems that optimise the equitable supply of vaccines throughout a region with data-driven orchestration of in- and outbound logistics and materials in pandemic and routine periods.

7. Governance harmonisation to equitably resolve issues and to support regional agreements, mutual recognition, technology licensing agreements and market access regulations across the region.

Every region can fine-tune RVMC Framework pillars to satisfy the unique manufacturing capacity and equity requirements of its members and plug gaps exposed in global and country responses during COVID-19. Fundamental stakeholder alignment on regionalisation will set the stage for longer-term technological progress that can be sustained. This includes creating focused agreements that support increased vaccine production, market uptake and equitable, consistent resolution of issues. All of this presents us with an opportunity to create a system that will ensure equitable access to vaccines for all. We must take advantage before it slips away.

For information regarding the RVMC kindly reach out to Lora du Moulin, Global Health & Security Lead, World Economic Forum